F2 in Palliative Care/Geriatric Medicine 19

Outline of Post

This is a four-month rotating F2 post in Palliative Care and Care of the Elderly. It is designed to offer trainees the knowledge, skills, competency and attitudes that should be developed during the foundation programme before proceeding to basic specialist or GP training.

The trainee will spend just overhalf (0.6 WTE) of their time in Palliative Care, including a session in the lung cancer clinic, and the remainder of the time on an Elderly Care Ward, Ward 19.

Palliative Care

St Clare’s Hospice is an independent hospice situated on the Primrose Hill site in Jarrow. It is an independent charity overseen by the Chief executive David Hall, and has a board of trustees. Its clientele are NHS patients with Palliative Care needs with a range of diagnosis including advanced malignant disease, neurological conditions ie. MS, MND, and other chronic conditions eg, COPD, CCF. The inpatient unit has 8 beds, one of which is for respite care. There is a 20 place day care unit, providing day treatment as well as general, supportive care. There is alymphoedema service, a clinical psychologist and a bereavement counselling service, and a rolling programme of fatigue management and breathlessness workshops.

The inpatient and day care units are staffed by trained, specialist palliative care nurses and health care assistants, with a large team of enthusiastic volunteers.

Medical staffing consists of a full time Hospice medical director Dr Petronela Dima, and three part time Hospice Physicians, all employed by the charity. There are two part time palliative care consultants for South Tyneside, Dr Anna Porteous, and Dr Ann Paxton who both have some clinical input into the hospice, and cover the general hospital and the community respectively. They will provide clinical supervision, with day to day supervision on the palliative care days also from the hospice staff, hospital and community specialist nurses.

The Community team comprises a team of Macmillan Community Specialist Palliative Care Nurses, two specialist Social Workers, two Occupational Therapists, a Clinical Psychologist, and a Physiotherapist.The hospital also has a Palliative Care Specialist Nurse. There is also the opportunity to see and contribute to outpatient oncology sessions, and attend the Lung Cancer clinics with Dr Mark Shipley, and Dr Liz Fuller.

The week will consist of spending one day in the hospice(including an MDT meeting for hospice inpatients), one day in the community (including an MDT meeting for community and hospital patients), a morning with the hospital team andamorning in a lung cancer clinic. The remaining 2 days will be spent on ward 19.

The F2 will be expected to assess, review, and admit palliative care patients, supported by the specialist nurses and doctors. They will gain knowledge in holistic assessments, symptom control, communication skills, care at the end of life, multidisciplinary team working, and who and when to refer patients to AHCP’s.

Elderly Care – ward 19

Ward 19 is a 29 bed unitwith patients under the care of Dr Thiru (working three days per week) or Dr Scott. It is an acute geriatric ward and patients are typically complex with multiple co-morbidity. The medical team consists of two F1s, two F2s (F2 Palliative care Half-Time), a Staff Grade (Rachel King) and a Registrar/ST3+. Other members of the multi-disciplinary team include nursing staff (Ann Callaghan Supervising Ward Sister/Manager) physiotherapy, occupational therapy, social workers, speech and language therapists (SALTs), dieticians, specialist nurses (MHLN etc.) and many others.

The F2 trainee will be expected to review all new patients admitted to the ward in conjunction with the F1 trainee, and be able to provide a summary of the diagnosis and initial management to their senior colleagues. They will provide prospective cover for other colleagues who may be absent from the ward. They will share responsibility for arranging investigations and documenting management plans with the other members of the ward medical staff.

All F2 trainees must attend the clinical and professional learning programme which runs on one half day every month. F2 trainees must complete an Advanced Life Support course (for which study leave and funding will be granted) and all trainees have the opportunity to spend 10 days in other specialities as part of study leave ‘taster sessions’. Such taster sessions are subject to satisfactory attendance at the professional learning programme.

Generic skills

  • Developing skills of history taking, examination and differential diagnosis
  • Arranging appropriate tests for the patients and checking results
  • Initiation and review of treatment
  • Effective handover
  • Supervision of junior F1 trainees.
  • Communication skills.
  • Liaison with primary care teams via telephone and written communication
  • Note keeping
  • Medico-legal issues.
  • Understanding clinical governance and the role of audit
  • Death confirmation, certification and the role of the coroner

Specific skills

  • Assessment of unselected acutely ill older patients
  • Management of acute and chronic medical problems in older adults
  • Discharge planning and multidisciplinary team working
  • Ethical issues for example DNACPR orders, advance care planning and the management of patients who lack capacity
  • Management of polypharmacy
  • End of life care
  • Breaking bad news to patients and their families/carers

Timetable

MONDAY / TUESDAY / WEDNESDAY / THURSDAY / FRIDAY
AM / Hospice MDT 9am-10am
Hospice – review patients / Lung Cancer clinic STDH / Community and hospital palliative care MDT and patient visits / Ward 19 consultant ward round / STDH palliative care ward round
PM / Hospice –review of patients/new admissions/day care / Ward 19 / Trust Grand Round12:30 – 2
(Education Centre)
Community visits / Ward 19 / X-ray meeting STDH 12.30
Ward 19
PM / Hospice MDT / Ward 19 MDT/case conference
Ward work / Community visits with Macmillan nurses / Falls/tilt clinic
Ward work / Ward 19

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F2 Palliative Care/COTE job description 2017